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PubMed1994

Gun safety practices of trauma center workers in a southern city.

We designed a study to assess the personal gun ownership and safety practices of trauma center workers in Birmingham, Alabama. Survey questionnaires administered to nurses, physicians, and other workers in pediatric and adult trauma centers showed that two thirds (65%) owned a gun and 56% owned a handgun. Gun owners with children were less likely to have loaded, unlocked guns in their homes than those without children (33% vs 56%). Loaded guns were carried in cars by 48% of workers. Worker title and attitude regarding handgun restrictions were the strongest predictors of unsafe gun ownership in a logistic regression model. Workers with loaded, unlocked guns in their home considered themselves and their family at no greater risk of gun injury from family-owned guns than workers without guns. We conclude that many trauma workers had unsafely stored guns and failed to recognize the associated risks.

Adult↗
PubMed2006

The association between hospital characteristics and rates of preventable complications and adverse events.

BACKGROUND/OBJECTIVES: This study examined the statistical relationship between hospital ownership and teaching status and hospital rates for potentially preventable adverse events measured using patient safety indicators recently developed by the Agency for Healthcare Research and Quality. RESEARCH DESIGN/MEASURES: A nationally representative sample of hospitals grouped into mutually exclusive combinations of control/ownership, teaching status, and rurality was defined using the Nationwide Inpatient Sample data set for the year 2000. Hospital rates for 5 categories of preventable adverse events were measured in 3 forms: unadjusted, risk-adjusted, and risk-adjusted ratios with smoothing. Multivariable regression analysis was used to measure the statistical significance of the relationship between hospital type and rates for potentially preventable adverse events, with adjustments for differences in hospital bed size and region. RESULTS: This analysis found an inconsistent relationship between categories of hospital type and quality care measured by alternative indicators of potentially preventable conditions. CONCLUSIONS: Hospital ownership and teaching status is not a consistent predictor of differences in rates of potentially preventable adverse events, and these characteristics explain little of the observed variation in the rates of these events across hospitals.

Hospitals↗
PubMed2006

Exceptions to the Stark law: practical considerations for surgeons.

BACKGROUND: The purpose of this study was to provide an understanding of the applicable legislative exceptions to prohibitions under the Stark law, which governs common legitimate business relationships in surgical practice. METHODS: Stark I and II prohibits all referrals (and claims) for the provision of designated health services for federal reimbursement if a physician or immediate family member has any financial relationship with the entity. Regardless of intent (unlike the antikickback statute), any financial relationship is illegal unless specifically excepted by statute. These exceptions are relevant to ownership, compensation arrangements, or both. The most important ones relevant to surgeons are as follows: physician service exception (services rendered in an intragroup referral); in-office ancillary services exception (office-based vascular laboratory); the whole hospital exception (ownership interest in a hospital or department); lease exception (conditions that must be met for a lease not to be considered illegal); bona fide employment exception (important to academic medical centers); personal services arrangement exception (vascular laboratory medical directorship); physician incentive plans exception (if volume or value of referrals are an issue); hospital-affiliated group practice exception (physician services billed by a hospital); recruitment arrangement exception (inducements by hospitals to relocate); items/services exception (transcription services purchased from a hospital); fair market value exception (covers services provided to health care entities); indirect compensation arrangements (dealings between a hospital and entity owned by physicians); and academic medical centers exception (new phase II rules broaden the definition of academic medical centers and ease the requirement that practice plans be tax-exempt organizations, among other changes. CONCLUSIONS: Although expert legal advice is required for navigation through the maze of Stark laws, it is incumbent on surgeons in private practice and at academic centers to have basic knowledge of exceptions under this burdensome statute. Antikickback "safe harbors" provide some protection against possible Stark violations. Penalties for violating Stark laws are severe, including fines of up to $15,000 per service and the economic threat of exclusion from participation in federal health care programs.

Academic Medical Centers↗
PubMed2000

Causes of cost inefficiency in HMOs.

Estimates a total effects cost function using a national 1994 health maintenance organization (HMO) data set to examine and update findings related to HMO efficiency. The cost function controls for ownership characteristics (profit status and ownership), size, enrollment diversity, regional location, product diversity, model type, payment characteristics, and years of operation. While not explicitly controlling for quality or acuity, measures of plan and enrollee diversity help control for aculty and quality. Results show that most of the difference in cost efficiency between HMOs is explained by factors specific to the HMO, including efficiencies of scale and scope, lower levels of Medicare patients, and efficient levels of capital. The study also shows that for-profits are more efficient than non-profits because they rely less on withhold pools to control costs. Limitations of the study include weak controls for quality of care, and limited data related to payment characteristics.

Aged↗
PubMed2001

Carrying their own medical records: the perspective of pregnant women.

Freedom of information, access to and ownership of medical records are current and controversial issues in Australia. Relating to pregnancy and birth the debate provokes emotional responses and raises important questions about access to information, decision-making, responsibility, power and control. The aim of this qualitative study was to explore the impact on pregnant women of carrying their medical records throughout pregnancy Twenty-one women participated in face-to-face individual interviews, which were coded for thematic analysis. The study found the reaction of women toward carrying their own records to be overwhelmingly positive. Maternal record holding had the potential to improve the level of communication between the health care worker and the pregnant woman and provided a greater sense of sharing and communication within the family The study also established that maternal record holding was of benefit to the woman's partner who was better informed and more involved in the pregnancy All but one of the women who participated favoured carrying their records in subsequent pregnancies. A concern about the potential for losing or misplacing records was not seen in this study, as no women lost their records. A sense of ownership would argue against this possible drawback.

Access to Information↗
PubMed2005

Administrative and research policies required to bring cellular therapies from the research laboratory to the patient's bedside.

The research process is a balance between the inherent risks of new discoveries and the risks of research participant safety. Conflicts of interest, inherent to the research process, as well as those introduced by emerging cellular therapies, have the potential to compromise safety. The relationship of trust between the researcher and the clinical trial participant facilitates objective decision making, in the best interest of both parties. In the setup of each clinical trial, investigators incorporate ethical, political, legal, financial, and regulatory considerations as protocols are established. Responsibility to abide by these decisions ensures a systematic process and safeguards participants in this process. The integrity of the research process is strengthened by identifying potential conflicting issues with the guiding principles established in the protocols, which may threaten the objectivity of involved parties and jeopardize safety of the participants. The rapid pace and changing paradigms of new discoveries in cellular therapies exaggerate existing conflicts and introduce new ones. Ethical issues raised by emerging cellular therapies include the division of opinions regarding the use of embryonic and fetal tissue to develop stem cell lines for research, the individual versus professional conscience of a researcher, overselling of outcomes as a result of the researcher's desire to be the first to discover a cellular therapy, and therapeutic misconception resulting from a participant's desire for a miracle cure. The basic ethical issue of whether stem cells should be utilized as a cellular therapy raises heated debates because some believe that it is not acceptable to use fetal material as a source of research material for future cures and others feel equally as strong that inaction is unethical because it results in needless suffering and death owing to the absence of this research. Political issues include the divergent position statements of presidential administrations on cellular therapy, variations in individual state laws, and states becoming involved in research funding, such as California's Proposition 71. Legal concerns include expanding private litigation with diversity of lawsuits, expanding lists of defendants, and the use of class-action lawsuits in research cases. Ownership issues also arise in terms of intellectual property, patents, and ownership of stem cells collected from minors, as in umbilical cord blood donations. Situations that challenge the regulatory processes established to ensure participant safety include differences in reporting requirements for private- and public-funded research and the lack of adequate funding and resources to implement and support the institutional review board (IRB) process. Financial considerations influence the development of clinical protocols, because funding is often limited. Financial incentives, personal investment in companies funding research activities, and fundraising pressures may present potential conflicts. In addition, the increasing role of emerging biotechnology start-up companies and pharmaceutical companies in clinical research introduces additional financial considerations. Administrative policies are needed to address these possible conflicts and ensure research participant safety as cellular therapies progress from the research laboratories to the patient's bedside. Administrative policies to ensure minimum standards of quality for emerging products before human clinical trials, policies to enforce consistent reporting requirements for private and public cellular research, policies to minimize financial conflicts of interest, policies to strengthen implementation of the existing IRB process and to structure into the process a consistent, systematic review of these identified conflicts, and policies to limit private litigation will help to preserve the objectivity of the review process and ultimately increase participant safety.

Cell- and Tissue-Based Therapy↗
PubMed2005

Factors influencing the use of registered nurse overtime in hospitals, 1995-2000.

PURPOSE: To assess nurse overtime in acute care general hospitals and the factors that influence overtime among various hospitals and in the same hospitals from year to year. METHODS: Staffing data from 1995 to 2000 from 193 acute general hospitals in New York State were used to examine hospital characteristics (size, location, RN unionization, hospital ownership, and teaching status) to determine whether they were associated with nurse overtime. RESULTS: The average weekly overtime RNs worked was 4.5% of total hours, varying from almost none to 16.6%. At mean overtime levels, nurses were working less overtime than the mean for manufacturing workers, but, at the extreme, nurses were working more than 6 hours overtime per week. Significant differences were observed in the use of overtime by hospital ownership and by union status. Nurses in government hospitals worked less overtime than did those in nongovernment hospitals. Nurses in unionized hospitals worked slightly more overtime than did nurses in nonunionized hospitals. CONCLUSIONS: Hospitals varied dramatically in their overtime use. That some categories of hospitals (e.g., government-owned) used little overtime indicates that hospital management can find substitutes for overtime to meet fluctuating staffing needs. The finding that hospitals with similar characteristics varied greatly in their number of overtime hours also supported this conclusion.

Acute Disease↗
PubMed2002

Why do rural primary care physicians sell their practices?

This study evaluates why rural primary care physicians sell their practices. A random sample of rural primary care practices in California, Utah, Ohio, Texas, and Virginia were surveyed to investigate changes in ownership of the practices during the period 1995-1998. These five states were selected because they represent areas with different experiences with physician-hospital integration and varied rates of managed care penetration. A series of logistic regressions were conducted to examine the factors that led independent physicians to sell their practices to either nonlocal buyers, local hospitals, or local physicians. Findings suggest that sales to nonlocal buyers represent the majority of practice ownership changes. The motivations for ceding control to nonlocal buyers center on managed care concerns, recruitment concerns, and administrative burdens. Sellers were also concerned about their level of net income prior to being acquired. However, the preacquisition financial concerns of sellers were not significantly stronger than the financial concerns of practices that remained independent. The environmental conditions that motivate rural physicians to sell their practices are not expected to improve. Therefore, additional sales of rural primary care practices to nonlocal buyers are expected. Further research is necessary to determine whether this shift in control will lead to changes in the quality or accessibility of care.

Analysis of Variance↗
PubMed1984

Biotechnology as an intellectual property.

Recent advances in biotechnology have created many public policy and legal issues, one of the most significant of which is the treatment of biotechnological industrial products, particularly under the patent system. Patents represent one of several types of intellectual property; their ownership confers the right to exclude others from benefitting from the tangible products of a proprietary subject matter. Intellectual property law and its protections will play a major role in the rate at which biotechnology develops in the United States. In this article biotechnological intellectual property issues are reviewed in the context of their underlying legal requirements. The implications of other factors, such as international competition, research funding, and gene ownership, are also considered.

Biomedical Research↗
PubMed2000

Public opinion about guns in the home.

OBJECTIVES: (1) Determine the frequency of gun ownership, acquisition, and transfer; (2) assess gun storage practices; and (3) compare the views of firearm owning and non-owning adults regarding the protective value of keeping a gun in the home. SETTING AND METHODS: Over three different time periods (1995, 1996, and 1999) stratified, random digit telephone surveys were conducted in a five county area of metropolitan Atlanta, Georgia. Five hundred adults (aged 21+ years) responded to each survey. RESULTS: The proportion of Atlanta area households reporting firearm ownership was generally stable over this interval (38%, 40%, and 35% respectively). The percentage of gun owning households containing a handgun (approximately 75%) was stable as well. In 1995, more than half of gun owning households kept one or more guns unlocked; since that time, the trend has been gradually downward. In 1995, 44% of gun owning respondents kept one or more guns loaded, compared with 38% in 1996 and 40% in 1999. A majority of respondents to all three surveys (55%) agreed with the statement "A home with a gun is less secure than a home without a gun, because a gun can be involved in an accidental shooting, suicide or family homicide". Among five home security measures, respondents rated a burglar alarm most effective, and keeping a gun in the home least effective. CONCLUSIONS: In Atlanta, many households keep a firearm for protection, but they are ambivalent about the associated risks. These findings suggest that education about gun safety should include a discussion of the risks of unsafe storage, and non-lethal alternatives for home security.

Adult↗
PubMedDate not supplied

Trends in students' knowledge, opinions, and experience regarding dental informatics and computer applications.

OBJECTIVE: This study investigated knowledge, opinions, and experience regarding dental informatics and computers among first-year dental students (D1s) and fourth-year dental students (D4s). DESIGN: First-year (N = 95) and fourth-year (N = 91) students in 1990 and first-year (N = 97) and fourth-year (N = 91) students in 1993 at a school of dentistry were surveyed. MEASUREMENTS: Demographic characteristics and computer ownership were assessed. Knowledge was measured using an 18-item scale (range 0-18). Opinions were measured using a 13-item scale (range 13-65; alpha = 0.81). Experience was measured using a 28-item scale (range 28-140). RESULTS: Response rates were all nearly 100%. Computer ownership by the D1s increased from 17.9% to 43.8% in the three years between surveys. Knowledge and opinions of the 1990 and 1993 D1s were similar, although the latter reported more experience with hardware and software. Experience with dental informatics applications was lacking in both groups. The 1993 D4s had completed more computer courses than had the 1990 D4s (2.3 vs 0.9), and demonstrated significantly more knowledge and experience. Opinion scores were nearly identical for these groups. The D4s in 1993 who had been D1s in 1990 had increased their knowledge of and experience with informatics applications during dental school. A difference in computer knowledge between the entering D1 males and females was observed in 1990, but was essentially gone by 1993 for the same individuals. CONCLUSIONS: Entering students had more computing knowledge and skill than their predecessors. Informatics knowledge and experience increased during dental school, and knowledge disparities between genders disappeared.

Adult↗
PubMed2006

Bodily rights and property rights.

Whereas previous discussions on ownership of biological material have been much informed by the natural rights tradition, insufficient attention has been paid to the strand in liberal political theory represented by Felix Cohen, Tony Honoré, and others, which treats property relations as socially constructed bundles of rights. In accordance with that tradition, we propose that the primary normative issue is what combination of rights a person should have to a particular item of biological material. Whether that bundle qualifies to be called "property" or "ownership" is a secondary, terminological issue. We suggest five principles of bodily rights and show how they can be applied to the construction of ethically appropriate bundles of rights to biological material.

Beneficence↗
PubMed2000

Variation in the quality of lumbar spine MR images in Washington State.

PURPOSE: To investigate the variation in quality of lumbar spine magnetic resonance (MR) images as a function of type of ownership of the imaging center, number of studies performed per month, specialty training of the image interpreter, and field strength of the MR unit. MATERIALS AND METHODS: Data were collected from all imaging facilities in western Washington state that received reimbursement from the Washington State Health Care Authority. Three readers with expertise in spine imaging, who were blinded to center and patient identification information, rated the technical image quality of each study. All MR images of the lumbar spine (maximum of six) paid for by the health care authority were evaluated. If a center had performed more than six studies, then six were randomly selected for evaluation. RESULTS: Variation in quality scores among sites was significant (P =.001). Field strength was the strongest predictor of better quality. Poorer quality was associated with for-profit ownership, a larger number of radiologists at the site reading MR images, and a larger percentage of studies checked by a radiologist prior to the end of the examination. CONCLUSION: There was significant variation in the quality of MR images of the lumbar spine, and at least a portion of this variation was attributable to characteristics of the imaging center.

Ambulatory Care Facilities↗
PubMed1984

The case for investor-owned hospitals.

The author presents the case for investor-owned hospitals based on his work experience in both nonprofit and for-profit hospitals. Viewing investor-owned hospitals as a natural development within a capitalistic democracy, he discusses the origins of the moral, ethical, and political arguments used against for-profit hospital care, as well as the increasing necessity for all hospitals to follow the laws of sound economic practice. Finally, having seen good and bad hospitals in every ownership category, the author believes that issues of cost and quality depend not on type of ownership, but on a complex set of variables including goals, management, personnel, and fiscal and physical resources.

Biomedical Research↗
PubMed1993

Family experiences, attitudes, and household safety practices regarding firearms.

To assess families' experiences with shootings and firearm ownership and attitudes, 208 children aged 5 to 12 years were interviewed and 242 parents filled out a questionnaire, all at an urban hospital. Forty-three percent of the parents and 25% of the children had personal knowledge of shootings. Of the parents, 10% owned guns, of which only 21% were stored safely. Gun ownership was more common in homes with resident adult males (14%) than in those with no adult males (3%). Most children (81%) played with guns, and 20% to 25% preferred violent TV shows, games, and toys. Parents' and children's attitudes toward firearms and children's gun play did not differ by level of mother's education; method of payment for, or site of, health care; income; or exposure to shootings. Children with personal knowledge of shootings more often expressed fears of being shot than did other children (52% vs 31%). The children in our study population were similar in their gun play and attitudes about gun use despite disparate socioeconomic backgrounds and exposure to shootings.

Adult↗
PubMedDate not supplied

Work organization, area labor-market characteristics, and depression among U.S. nursing home workers: a cross-classified multilevel analysis.

Associations between forms of work organization that follow globalization and depression were examined in U.S. nursing home assistants. A cross-sectional study of 539 nurse assistants in 49 nursing homes in three states in 2000 assessed nursing home ownership type, managerial style, wage policy, nurse assistants' emotional stresses, and area labor-market characteristics (county income inequality, median household income, and social capital) in relation to the prevalence of depression among the nurse assistants. A cross-classified multilevel analysis was used. For-profit ownership, emotional strain, managerial pressure, and lack of seniority pay increases were associated with depression. Labor-market characteristics were not associated with depression once work organization was taken into account. The deregulation of the nursing home industry that accompanies globalization is likely to adversely affect the mental health of nursing home assistants.

Adult↗
PubMed2005

Adoption of shelter dogs in a Brazilian community: assessing the caretaker profile.

A survey in Ibiúna, Sao Paulo, Brazil, of caregivers (owners) who adopted shelter dogs assessed length of ownership, proportion of male and female dogs adopted, and owners' characteristics. It addressed breeding, neutering, vaccination, and veterinary care. It used no testing to provide a good "match" between dog and future owner. Of adopted dogs, 58% were male. Only 36% of owners were located. Mean ownership length was 14.8 months (95% confidence interval = 12.4 to 17.2 months), estimated through a survival analysis method. Of adopted dogs, 40.9% lived with their owners; 34.9% had died (some had lived on the streets); 15.0% were donated; 4.3% ran away; 3.2% were returned to the city shelter. Of interviewees, 57% reported no difficulties with the adoption; 23.1% cited the animal's illness and death as the main difficulty. For contraception, 87 owners (46.7%) chained dogs to prevent contact with other animals; 56.5% were against neutering. Reasons given were compassion (58.1%), unnecessary procedure (11.4%), cost (9.5%), and behavior change (4.8%). This research motivated a design for Ibiúna shelter dog adoption to improve the proportion of successful adoptions.

Animal Welfare↗
PubMed1990

Physician-management relationships at HCA: a case study.

The questions of whether Hospital Corporation of America (HCA), a for-profit hospital company, fostered an environment detrimental to the physician-patient relationship during the period of implementation of the Medicare Prospective Payment System (PPS) was explored. The transition to PPS provided an opportunity to evaluate whether hospital ownership differences affected responses to a payment system which encouraged institutional intervention in the practice of medicine. A case study approach was used to observe the influence of the then largest for-profit hospital corporation upon physicians' medical practice in four owned hospitals. Findings indicated that HCA hospital managers were most directly influenced by the local competitive environment and their own personal agendas in responding to PPS incentives. Corporate influence actually softened payment system incentives to intervene in medical practice by providing a generous supply of capital, and by fostering a corporate culture conducive to cooperative relationships with physicians. Better public understanding of the determinants of hospital behavior is needed to preserve or enhance important social goals such as the physician-patient relationship; easily measurable characteristics such as ownership or bed size explain little about hospital behavior or motivation.

Economic Competition↗